Provider Demographics
NPI:1619384682
Name:SUND, SUZANNE SHERYL (LMP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:SHERYL
Last Name:SUND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:SUND
Other - Last Name:GILLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1728 STATE AVE. NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-352-2488
Mailing Address - Fax:360-943-5156
Practice Address - Street 1:1728 STATE AVE. NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-352-2488
Practice Address - Fax:360-943-5156
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60437003172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist